As the IMA strike is called off following assurances by Chief Minister Devendra Fadnavis, Dr Dilip Sarda, member of Maharashtra Medical Council and former president of Maharashtra unit of IMA and Dr Jayant Navrange, chairman of the medico-legal committee of IMA at an Idea Exchange at The Indian Express talk on why the incidents snowballed into a major issue leading to mass bunking and what needs to be done
ANURADHA MASCARENHAS: Resident doctors at government medical colleges across the state have been on mass casual leave for five days demanding security. Why did Indian Medical Association (IMA) get into the picture and go on an indefinite shutdown of OPD services?
DR NAVRANGE: IMA is the parent body of doctors and what happened in Dhule was a brutal attack on an orthopaedic doctor at a civil hospital. Dr Rohan Mhamunkar almost lost his vision after 20-25 relatives of a patient beat him up.
A week after the Dhule incident, there were again another six attacks on resident doctors in various parts of the state. Somewhere we had to speak up as enough is enough. In the last seven years, there have been 56 cases of assault against doctors with seven in Pune. But no action has been taken and the accused gets released on bail in 24 hours. Hence, we supported the resident doctors and 40 associations have come together under the banner of Doctors Medical Security Forum that went on a statewide strike.
The response from doctors in both small clinics and large hospitals has been spontaneous with several shutting their OPD.
SUNANDA MEHTA: Why has the Doctors’ Protection Act of 2010 failed to provide security to the doctors? It already has the provisions for imprisonment and fines.
DR SARDA: It is not a Central Act. So far it’s only in 18 states. Also, it is not in the curriculum of the police, so most of the police officials do not even know about it. Finally, while the punishment is laid down, there is no implementation by the government, hence, it fails to act as a deterrent for the attacks.
We are asking for security personnel for all the 16 government medical colleges in the state. The colleges should be manned by adequate security persons who can prevent these attacks on the medicos. While this issue exists in other states too and is not particular to Maharashtra, we want to make our state a role model for the solution and implementation of the Doctors Protection Act.
SUSHANT KULKARNI: The key demand is of providing security. Do you think it will be feasible to provide security to every doctor? Right now we are talking about medical colleges. What about the district hospitals, PHCs? Don’t you think they are even more vulnerable?
DR NAVRANGE: The corporate hospitals are capable of providing their own security unlike small private hospitals and the PHCs. We have to start thinking about long-term solutions.
We have formed regional WhatsApp groups, of at least 100 doctors each from individual areas. So whenever there is an incident, neighbouring doctors can rush and prevent that incident. We call it the Pune model, which has proved to be very effective in last two-and-a-half years.
We also realised that police are not aware of the existing law. Every time a new police chief comes, we have to brief them about the act. This is because this law has not been included in their curriculum. Even police stations are not aware of it. So when then police commissioner KK Pathak issued a departmental order to individual police stations, it worked really well. Also, we need to have regular communication with local police stations.
We believe this model will work for every unit across the state. It is of no use to just call them when in crisis. This has worked in Pune in several cases. SUSHANT KULKARNI : Then aren’t we looking at a situation where relatives and doctors will be at loggerheads?
DR NAVRANGE: No. We are not looking at tit for tat kind of scenarios. But in present condition, this seems to a workable model to protect ourselves.
ALIFIYA KHAN: There is not much awareness about this law. And here, aren’t doctors partly to blame? How many hospitals/private clinics have put up signages? Like it was done while implementing the PCPNDT Act.
DR NAVRANGE: Most big hospitals do have these posters and signages, especially outside emergency rooms. Yes, it is not there in nursing homes, clinics etc. I think to spread awareness, we need to ensure it is visible to patients and caretakers at all these places. We will soon publish a notice in IMA newsletter, which doctors can put up .
ANURADHA MASCARENHAS: Why is there a lack of communication between doctors and patients. Is there no provision to introduce communication skills in the MBBS curriculum.
DR NAVRANGE: There is a lack of communication between patients and doctors and in the last few years, communication skills have been introduced as a module in the second year MBBS course.
DR SARDA: At IMA, we have conducted several continuing medical education programmes on this issue and emphasised on the importance of medical ethics.
There are challenges in the healthcare environment but good communication eventually means the need to respect each other and also manage expectations. More efforts need to be taken to establish this rapport.
ALIFIYA KHAN: One of the demands is to restrict the number of relatives who accompany patients in hospitals. But why cannot the medical college dean issue such orders at their own level?
DR NAVRANGE: Yes, the hospital dean or medical superintendent should do it at their own level. But we are seeing that this is not happening, in case of Dhule it didn’t happen.
DR SARDA: Even if hospitals do put such restrictions, they are not followed. We don’t want just orders. They need to be implemented too. Previously, the state had issued a similar order, but was it followed? Who will restrict relatives and how can one doctor face 20 relatives in an ICU?
ANURADHA MASCARENHAS: With rising cases of attacks against doctors, can MMC play an effective role.
DR SARDA: MMC is a quasi judicial body and we do get cases of medical negligence against doctors.
There has been a backlog of 700 cases of medical negligence and it has been resolved over the last few years.
DR NAVRANGE: The MMC has no jurisdiction over criminal cases or complaints of doctors against patients.